287 claims resolution coder jobs found

City / StateNorfolk, VAWork ShiftFirst (Days)Overview :Claims Resolution Coder- RemoteResponsible for reviewing medical documentation to assign modifiers to insurance claims with issues identified by the National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE),or other third party payer specific claims processing guidelines.Works with Coding, Billing and Reimbursement staff to resolve edits.Is additionally responsible for trending errors, supporting identification of root causes, and effective communication with coding and training staff to improve coding accuracy and clean claims processing.Researches regulations to ensure accuracy of CPT codes and documentation.Associates degree in Health Information Technology or Medical Billing preferred.2 years direct application of coding, medical billing or reimbursement in health care setting, hospital or physician office required.CPC or CCS coding certification required at time of hire.Thorough knowledge of lab,...

Professional/Physician Medical Coder I page is loaded## Professional/Physician Medical Coder Iremote type: Hybridlocations: Cleveland, TNtime type: Full timeposted on: Posted Todayjob requisition id: JR100427At Vitruvian Health, we serve with compassion. As northwest Georgia and southeast Tennessee’s leading healthcare system, we are committed not only to the health of our communities, but also to the growth, support, and success of our team members.Formerly Hamilton Health Care System, Vitruvian Health is built on a legacy of trust, innovation, and exceptional care. With over 80 points of access across the region, including Hamilton Medical Center and Bradley Medical Center, we offer the opportunity to be part of something bigger: a connected, mission-driven team changing lives every day.Our core values, Professionalism, Respect, Integrity, Diversity, and Excellence (PRIDE), guide everything we do. We believe in empowering our people, celebrating differences, and...

Remote Inpatient Coder - HIMJOB SUMMARYThe Health Information Management (HIM) Coder impacts Memorial's Healthcare quality initiatives and reimbursement through the assignment of the most accurate and optimal diagnosis and procedural codes to individual patient health information for data retrieval, analysis, and claims processing.Under the direction of the Health Information Management (HIM) Coding and Clinical Documentation Integrity (CDI) Manager, this position will code and analyze physician documentation contained in health records (electronic, paper or hybrid) to determine the appropriate principal diagnosis, secondary diagnoses, and procedures codes to accurately capture MS-DRG assignment.Use the Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers in accordance with coding rules and regulations.The coding information is used to determine APC's (Ambulatory Payment Classification) for data...

GENERAL DESCRIPTION OF POSITION: This position is vital in the health care delivery system in function with the fiscal aspect of the Clinic. Adhere to policies and procedures in conducting all clinical charges, payments, adjustments for proper billing and collections. Bills and submits claims to insurances/programs through AthenaOne EMR, follows up on claims statuses, resolves claim denials, submits appeals, post payments and adjustments, and manages collections. Great customer service and telephone etiquette, computer knowledge, professional appearance, attention to detail, able to multitask and work in a fast paced environment. Ability to work well under stress and maintain calm under pressure and work well with team members and willingness to cross-train. Functions as a member of a collaborative health care team to create and maintain a patient centered medical home. ESSENTIAL JOB FUNCTIONS: (with or without accommodations) Communication : Communicates with outside...

POSITION SUMMARY This role is responsible for accurately and appropriately coding ambulance claims, including claim submission, follow-up on denied claims, and ensuring compliance with relevant billing regulations to facilitate timely reimbursement for services. ESSENTIAL JOB FUNCTIONS Examines patient care reports to gather essential information for insurance documentation. Contacts facilities, hospitals, or patients to acquire missing information and physician certification statements. Collects data such as insurance company names, policyholder details, policy numbers, and services provided to accurately complete claim and/or billing records. Communicates with insurance companies to verify coverage, determine payor schedules, and gather benefit details. Assigns relevant codes based on documented information in the patient care report and determines the appropriate level of ambulance service. Allocates charges for services supported by documentation in the patient care...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together. Under direction of the Coding Manager, the primary responsibility of the MedicalCoder is to ensure that codes representing current International Classification of Diseases, 9th Revision (ICD-9) or 10th Revision (ICD-10), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) accurately reflect documented services by applying a demonstrated knowledge of anatomy,...

Scheduled Weekly Hours: 0 Working under the supervision of the Central Billing Department Supervisors will share the responsibilities of being accessible to physicians, staff and patients regarding billing questions; assures that all billing functions are completed in a timely fashion and develops billing goals. Responsible for accurately coding provider's outpatient and inpatient visits based on the documentation provided and abstracting accurate and complete patient care data to ensure optimum and timely reimbursement. Applies knowledge of specialized information specific to coding and medical terminology according to all coding guidelines. Required Qualifications and Skills: Minimum of 1-2 years of medical billing experience in either charge, payment or follow-up work Minimum of 1-2 year of coding experience for primary care, medical and surgical specialties or secured CPC, CCS-P coding certifications. Excellent written and oral communication skills with attention...

Job Description Job Description Salary: $17-$21 Hour DOE Who we are: Cyti Corp is a diverse group of hard-working and talented individuals, who are brought together by our passion for offering quality mental health care, and our absolute commitment to helping children, adults, couples & families find greater happiness and meaning in their lives. Who you are: A reliable team member that thrives in a constantly changing environment, and who has a passion for helping others. Someone detail-oriented with an excellent communication style. About the role: Cyti Corp is looking for a well-rounded, experienced, and proficient medical biller/coder to join our team! The candidate will be highly organized and can work independently to ensure timely filing of claims, A/R follow-ups, and payment posting. This is an in office position located in Las Vegas, Nevada. There will be inbound calls from patients for payments as well as outbound calls to various insurance payers for...

Job Description Job Description Job Summary: We are seeking a detail-oriented surgical Biller and Coder with proven experience to lead the daily operations of our billing and coding department at our Babylon office. The ideal candidate will have strong leadership skills, a deep understanding of surgical billing and coding processes, and the ability to ensure accuracy, compliance, and efficiency across the department. Key Responsibilities Manage the end-to-end billing lifecycle for surgical and non-surgical services , from charge entry and claim submission through final resolution Ensure timely and accurate submission of claims, medical records, and operative reports through payer and insurance portals Monitor, analyze, and resolve claim denials, underpayments, and payment delays , including proactive follow-up to ensure timely reimbursement Initiate, track, and manage reconsiderations, disputes, and first- and second-level appeals in accordance with payer...

Job Description Job Description About the Role Our growing Ophthalmology practice is seeking an experienced Medical Biller with strong insurance and revenue cycle knowledge to join our team. This position plays a key role in maintaining the financial health of the practice while also supporting front desk operations to ensure a smooth patient experience. The ideal candidate has hands-on experience with ophthalmology billing, and is comfortable managing claims from submission through payment resolution. This is a great opportunity to join a patient-focused specialty practice where your billing expertise directly contributes to efficient operations and quality patient care. Key Responsibilities Submit and manage medical claims for ophthalmology services including office visits, diagnostic testing, and minor procedures Review and correct claim errors to ensure clean claim submission and maximize reimbursement Follow up on unpaid or denied claims and manage appeals when...

Job Description Job Description Job Summary: We are seeking an experienced Medical Biller & Certified Coder with a strong focus on Accounts Receivable to join our busy, high-volume Family Practice. This role is essential to maintaining the financial performance of the practice and requires a candidate who is highly skilled in A/R follow-up, denial resolution, and insurance collections. The ideal candidate is detail-oriented, persistent, and results-driven. Key Responsibilities: Manage and maintain all aspects of Accounts Receivable, with a focus on timely follow-up and resolution Investigate and resolve denied, rejected, and unpaid claims with insurance carriers Work aging reports to ensure prompt reimbursement and minimize outstanding balances Communicate with insurance companies to correct claim issues and secure payment Post payments and reconcile Explanation of Benefits (EOBs) accurately Submit corrected claims and appeals as needed Handle patient billing...

Professional Surgical Coder I Under experienced leadership the Professional Surgical Coder I is an advanced coding position that is responsible for accurate and timely assignment of codes to diagnoses and procedures for all outpatient and inpatient diagnostic and procedural coding. Using established department policies and procedures in conjunction with the current versions of ICD-10 and CPT-4, the Professional Surgical Coder I will determine the proper diagnosis, assign co-morbidities and complications, secondary diagnoses and any HAC (Hospital Acquired conditions) documented. As well as both E/M codes and procedure codes. The Professional Surgical Coder I is expected at South Shore Physician Ambulatory Enterprise to query providers when documentation requires clarification and he/she proactively works with medical leadership to address concerning documentation trends. The Professional Coder I works with direct support from and under the direction of the Billing and Coding...

Employment Opportunities Provides high level technical competency and subject matter expertise analyzing physician/provider documentation in Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined DRGs (APR), Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI) to ensure accurate hospital reimbursement. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments. Essential Functions: Knows, understands, incorporates, and demonstrates the Trinity Health...

JOB SUMMARY The Health Information Management (HIM) Coder impacts Memorial's Healthcare quality initiatives and reimbursement through the assignment of the most accurate and optimal diagnosis and procedural codes to individual patient health information for data retrieval, analysis, and claims processing. Under the direction of the Health Information Management (HIM) Coding and Clinical Documentation Integrity (CDI) Manager, this position will code and analyze physician documentation contained in health records (electronic, paper or hybrid) to determine the appropriate principal diagnosis, secondary diagnoses, and procedures codes to accurately capture MS-DRG assignment. Use the Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers in accordance with coding rules and regulations. The coding information is used to determine APC's (Ambulatory Payment Classification) for data quantitative analysis,...

Job Description Job Description ob Description We are seeking a seasoned Medical Billing Specialist (certified coder) for a busy practice of two Providers in Podiatry (George Dieter location opening soon!). Must have background or experience in a medical setting (private practice or hospital). The candidate should be a team player, ability to take initiative and multi task. This is a full time position, part time not available. Bilingual is preferred but not required. Please review the essential job function and you MUST meet the Position Requirements (certification must be attained within 90 days of employment). Essential Functions: The following description of job responsibilities and performance expectations is intended to reflect the major responsibilities of the job, but is not intended to describe minor duties or other responsibilities as may be assigned from time to time. Keys charge information into entry program and produces billing. Processing of insurance...

POSITION SUMMARY This role is responsible for accurately and appropriately coding ambulance claims, including claim submission, follow-up on denied claims, and ensuring compliance with relevant billing regulations to facilitate timely reimbursement for services. ESSENTIAL JOB FUNCTIONS 1. Examines patient care reports to gather essential information for insurance documentation. 2. Contacts facilities, hospitals, or patients to acquire missing information and physician certification statements. 3. Collects data such as insurance company names, policyholder details, policy numbers, and services provided to accurately complete claim and/or billing records. 4. Communicates with insurance companies to verify coverage, determine payor schedules, and gather benefit details. 5. Assigns relevant codes based on documented information in the patient care report and determines the appropriate level of ambulance service. 6. Allocates charges for services supported by...

Job Description Job Description Certified Medical Biller & Coder (In-Person) — Total Medical Billing Total Medical Billing is hiring an experienced Certified Medical Biller & Coder to join our team on-site . If you’re accurate, organized, and confident working claims from start to finish, we’d love to meet you. Responsibilities Assign accurate ICD-10, CPT, HCPCS codes and review documentation Submit claims, correct rejections, and manage claim edits Post payments (ERA/EOB), balance accounts, and resolve discrepancies Work denials, follow up on A/R, and submit appeals as needed Verify eligibility/benefits and maintain HIPAA compliance Requirements Current certification (CPC, CCS, CCA, or equivalent) 2+ years billing/coding experience preferred Strong knowledge of modifiers, payer rules, and denial resolution Detail-oriented with strong communication and time management Position In-person (Total Medical Billing) Full-time...

Description MAKE A DIFFERENCE AT OCHIN OCHIN is a rapidly growing national nonprofit health IT organization with two decades of experience transforming health care delivery to drive health equity. We are hiring for a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our mission. OCHIN provides leading-edge technology, data analytics, research, and support services to nearly 1,000 community health care sites, reaching nearly 6 million patients nationally. We believe that every individual, no matter their race, ethnicity, background, or zip code, should have fair opportunity to achieve their full health potential. Our work addresses differences in health that are systemic, avoidable, and unjust. We partner, learn, innovate, and advocate, in order to close the gap in health for individuals and communities negatively impacted by racism or other...

The Analyst II Coder, under the direction of the Revenue Manager/Associate Director, provides support in areas of revenue operations related to production coding, auditing, and training for their designated areas. Under general supervision, applies acquired skills as a revenue cycle analyst to perform charge capture and charge flow, PB coding, charge edit reviews, claim edits, RFIs, support setting up new charging practices/units, and reporting. Gaining expertise to act as a specialist for designated divisions. Manages a diverse range of 1,000 - 3,500 procedural code set combinations, plus Evaluation and Management services coding. Demonstrates core coding competency and proficiency in moderately complex duties, including Prof Fee and technical coding. Provides analysis to support department revenue cycle management and improve work queue design and management. Provides education and training to physicians and clinical staff on documentation to ensure compliance with coding...

Job Details Physician Office | Kettering | Full-Time | First Shift Responsibilities & Requirements Responsibilities & Requirements This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation.  KPN Pro Fee Coding Specialist Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines. Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits Reviewing the ambulatory records for the appropriate risk adjustment components Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10 Reviews and researches pending and denied claims pertaining to professional fee...

Job Description Job Description Our growing Ophthalmology practice has a vacancy for a Full Time Biller/ Coder role. This role will work on-site in our Chula Vista location and provide billing support to the corporate office as well as other satellite clinics. The ideal candidate has experience working in a collections role for an ophthalmology practice. This person will thrive in a busy, fast-paced environment and can multi-task while keeping a superb professional demeanor. The role will report to the Billing Manager. What do we need? We are seeking a talented and proficient Claims Denial Resolution Specialist/ Coder to join our growing team. At American Eye Associates we provide our Specialists the opportunity to learn, be challenged, and grow your career within the Revenue Cycle industry. Ideal candidates will possess claims processing experience and a competitive desire to maximize returns. What will you provide? · Understanding and proficient use of medical...

Job Description Job Description SUMMARY: In-person Full Time Billing Specialist performs diagnosis and procedural coding to individual patient health information for data retrieval, analysis, and claims processing. DUTIES AND RESPONSIBILITIES: Reviews the patient ‘s medical record for accurate and complete documentation prior to coding. Works closely with the physician coordinator regarding discrepancies found in patient’s record prior to claim submission Codes for assigned physicians, locations, and/or departments from review of medical record documentation. Applies knowledge of current coding and billing requirements to assure claims are submitted correctly Brings identified concerns and trends to the manager/team lead for resolution. Reviews coding and billing worklists and resolves claim rejections. Enters patient demographic information and verifies patient insurance coverage QUALIFICATIONS : Working knowledge of CPT and ICD10 coding Medical...

**CANDIDATES WITH PREVIOUS MEDICAL CODING EXPERIENCE WILL NOT BE CONSIDERED** About the Role Are you a newly certified medical coder looking to launch your career in a dynamic and fast-growing healthcare environment? Join a federally certified Independent Review Organization (IRO) that provides expert medical review services to government agencies, insurers, TPAs, and self-funded employers. This is a unique opportunity to be part of a team supporting a high-impact initiative driven by the No Surprises Act, with a mission to resolve complex claim disputes and ensure fair payment outcomes. What You'll Do * Review and validate claim data to determine appropriate payment outcomes. * Analyze CPT codes and supporting documentation to identify the correct party in disputed claims. * Work primarily with emergency services claims, including ambulance and air ambulance cases. * Operate within a proprietary claims management system. * Collaborate with internal teams to clear a...